Coverage for Members Who Are Hospitalized on Their Effective Clause Samples

This clause ensures that individuals who are already hospitalized on the date their insurance coverage becomes effective are still eligible for benefits under the policy. In practice, it clarifies that coverage will not be denied simply because a member was admitted to the hospital before their official start date, provided other eligibility requirements are met. The core function of this clause is to prevent gaps in coverage for new members who require immediate medical care, thereby protecting them from unexpected medical expenses during a critical transition period.
Coverage for Members Who Are Hospitalized on Their Effective. Date If you are in the hospital on your effective date of coverage, healthcare services related to such hospitalization are covered as long as: (a) you notify us of your hospitalization within forty-eight (48) hours of the effective date, or as soon as is reasonably possible; and (b) covered healthcare services are received in accordance with the terms, conditions, exclusions and limitations of this agreement. As always, benefits paid in such situations are subject to the Coordination of Benefits provisions.
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Related to Coverage for Members Who Are Hospitalized on Their Effective

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